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Tf-tS DAWNfNC. OF A NSW DAY

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Illness Management i

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Self-Directed Recovery

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Table of Contents ,


Talking Story Part 1 - Let's Get to Know Each Other.....,,....,,..,.,,,............,.....,,..,. 1

B Talking Story Part 2 - Kumu Ola Pono - The Wai' anae Wellness Model.......................2 D

I a: ng ::ory :ar:!- denti yin;hstcengthstan; Weaknesses..............................!....... I

pa hang

at way 1

07 ar. -h r;par1 g

- earning t e ract1caI

Fe oya e oB.ec ve6-.....d.. .................................

acts a out 1po ar 1sor er.............................5...

Pathway 2 - Learning the Practical Facts about Schizophrenia 6

Pathway 3 - Learning the Practical Facts about Depression ?

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;, Pathway 4 - A Look at the Stress-Vulnerability Model.......................................................8 ;x,

Pathway 5 - Building Circles of Friends 9

Pathway 6 - Using Medication Effectively................................................................1 0

Pathway 7- The Effects of Drug and Alcohol Use...........................................................1 1.

Pathway 8 - Solving Pilikia and Achieving Goals....................................................................1 2.

Pathway 9 - Building Strengths and Reducing Crises..........................................................1..3.. Pathway 10 - Getting Your Needs Met in the Mental Health System 14

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achment s..............................................................................................................................................15 P.i--'t'.'

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  1. DIE AND OLA ;'

    :. 2. Mahiki

    1. Stigma

    2. Hawaiian Code of Conduct

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5Four Agreements !, :,

6. Serenity Prayer

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  1. CuIt ura IC ompet ence

  2. Additional Community Resources

tl--';'.<il 10. Article: Contextualizing the symptom in multicultural consultation: Anger in a tl--'{<il tl-•\<il cultural-historical context tl-•\<ll

iX@ 11. Exploring the Ho' oponopono Process

!, :, Notes............................................................................................................................................................ 16 :,

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Addendum.............................................................................................................................................17 f{

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HaleNa'auPono

Wai'anae Coast Community Mental Health Center, Inc. 86-226 Farrington Highway Wai'anae, Hawaii 96792

Telephone: (808) 696-4211 Fax: (808) 696-5516

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Talking Story - (Part 1) D

Let's Get to Know Each

Other a

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Mq ''We l1°na00

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(A Wel'coming Call)

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Guiding Principles at Hale Na'au Pono :

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I;i Human societies operate on underlying beliefs, sometimes referred to as "Deep

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I Cultures." Some societies, especially where there have been intermingling of peoples, i_j-

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have a number of such cultures. In Hawai' i, we have two distinct deep cultures, one 1 based on domination, individualism, and exclusion, for which we use three reminder

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alphabets, D.I.E, and another based on 'oluolu (non-confrontational and pleasing), P.}-' lokahi (unity) & aloha (compassion, kindness, loving) for which we use O.L.A. We have chosen to be guided by the second, more caring, softer, sustaining and healthier culture. (See Attachment! on DIE and OLA)

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@ "HO' OMOE WAI KA-HI KE KA-0' O."

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direction.)

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'Olelo No' eau, Hawaiian Proverbs and Poetical Sayings,

Mary Kawena Puku' i, Bishop Museum Press (1983) #1102


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A Walk Around the Block

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Popo would push the baby cart around the two-mile block in Lualualei valley from Pu'uhulu Road, up Kuwale, down Lualualei, and across

Puhawai, to show her grand baby Pohaokalani the sights, smells and

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sounds of the country-side. Whenever she came to the pasture, she'd do l

the grandmother ""googoo---gahgah" routine, trying to build interest and

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excitement in her 1 year old grandson as they went past the horses and cows grazing. But all Poha would do was look disinterested and drool.

On the third day around the block, Popo needed more gratification

than she was getting for pushing the baby carriage two miles around.

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animals, she got the same non-response. I

Ij When she got to the pasture and stopped for the baby to see the So, Popo got her 70 year-old body down low, placing her eye level at

the level of Poha's, and there she saw what baby was seeing. All Poha

I could see was tall grass! I

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Popo laughed to herself at seeing what Poha saw, picked up her

Qi-•' grandson, stood up caressing him at her breast level, and gave Poha a t-.' i chance to see from her view. Poha's excitement at now seeing the horses , and cows gave Popo the reward for many more happy walks around the block.

As retold by Puanani Burgess from the telling by Popo

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Help us see the world through each ot he rs 0 eyesl

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Let's "talk story."

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Talking Story comes from all traditions. It is a basic tool of communicating. Talking story helps to build strong relationships and trust among people. It provides important information about how we think, feel, and dream. It displays the panorama of our cultural,

- sodaI, economic and historicaI bakc grounds. It

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ps us

become -

t}-'< aware of our own cultural beliefs and values, and shows sensitivity , and respect to other's. It helps tell about ourselves.


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-He-re's s-om-e-top-ics-w-e-cou-ld-sh-are.

-our 'Ohana, genealogy, & family life

I -our names and their meaning(s) I

I -our 'aumakua or spiritual angels I

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-our elders, kupuna, or wise folks


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-family worship, sacred places for worship

-the place we were born

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-our heroes/heroines, and why they are

-our favorite food, ethnic dishes

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IJ -our favorite place to live IJ

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fil -herbs or medicine we've found helpful

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Questions helpful in prompting us to tell our stories are:

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Where are your people from?

How many generations ago did your family/ancestors come to Hawaii?

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In what country were you born?

Describe your birthplace as best you know?

How long have you lived in Hawaii? In Wai' anae? Where were you raised?

Where does your heart calI home? ¥

a Who raised you? a

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How important is your 'ohana to you? I

Describe your 'ohana?

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Do you feel a strong connections to your 'aina hanau (land of one's birth, homeland)? Do you speak your native tongue?

Have you lost touch with your cultural roots?

Do you know the rituals of your ancestors? What is your dream of becoming?

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What traits you feel best describe you?

a}-'< What scares you?

How do you overcome your fears?

Where do you generally go for help overcoming problems?

Temple, Church or other sacred place? To prayer? Favorite place, quiet and serene spot in nature?

Find a friend, confidant, doctor, case manager, or family member to talk with? Take drugs, alcohol, or medicine to help you address the problem?


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  1. '< Hale Na' au Pono ,},.,;

    Wai'anae Coast Community Mental Health Center, Inc. '-

    86-226 Farrington Highway Wai' anae, Hawaii 96792 ;

    i"-'<1 Telephone: (808) 696-4211 Fax: (808) 696-5516 i-7 :;


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    VOYAGE TO RECOVERY

    Talking Story - (Part 2)


    ''Kumu Ola Pono 00

    Wai'anae Wellness Model


    The natural condition of a person and his spiritual, earthly and social

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    realm is balance. However, everyone goes through part of their life living a -

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    strained relationship with one or more realms. Things get out of balance. Sometimes, there may be a multiplicity of strains occurring at the same time. Hawaiian people would try to take one strain at a time, and address

    each separately, moving on step by step. Mahiki. At times, it may take manyl

    efforts to identify and take care of all of the strains that is causing disharmony. ij

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    One should try to maintain as much of the harmony within one's Kumu i

    Ola Pono as possible. Yet one needs to recognize that just as the world is always changing, there are constantly pressures in all of the realms, which


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    press upon one's Kumu Ola Pono. No matter how much we try, or how well we l

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    have realigned ourselves, wellness is an ongoing process. We are constantly challenged to stay in alignment, and when we fail to do so, recovering into

    ; wellness is always available to each of us.

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    One formulation for being well is to have a balanced relationship with all things, inside and out (internally and externally), up and down (heaven & earth), and all around (all the things and ideas which surround us). This has been an understanding from time immemorial. across all lands, among people of diverse religions, educaticm, and ethnicity.


    We express this understanding here from a Hawaiian perspective. In doing so. we are cautious that even among us. there remain divergent opinions. This is not the only Hawaiian perspective and is certainly not any better them as perceived by others.


    Our Kumu Ola Pono, or "model of wellness" incorporates three significant realms, each in "balance" or good relationship with one another, and with themselves. These three realms are the Akua/Aumakua (spiritual), the Kcmaka (humc.m/sodety}, and the 'Aina (Earth). This is sometimes expressed as God, Man and Nature.


    When relationships are aligned between and among each of these realms, there is wellness, balance, or pono. When relationships are out of line, there is uneasiness, discord. and illness. To achieve wellness, therefore, the task is dear - keep relationships porm.

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    All the Elements Are Interconnected and Interdependent

    2


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    Akua/ Aumakua Kanaka

    / ,)Observation can be an excellent teacher - if we take time

    ?v7 JYi to understand what we observe.

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    We have seen or heard of situations where a person is not well because of his relationship with his spiritual realm.


    ©@@@ © ©@ © © ©@ © © © © © © © © © © © © © ©©

    © ©

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    : Your pilikia may be with :

    : your God, or your aumakua, :

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    : or an ancestral spirit.

    © ©

    © ©

    © ©

    ® To get yourself into a right ®

    © ©

    : relationship, you may seek :

    : out a priest, spiritual :

    : counselor, or may resort to :

    ©

    ©

    : prayer and rituals, may : engage in ho oponopono, or : turn to medicine available ®

    in nature. ©

    ©

    ©

    © ©

    © ©

    © There are numerous ways in ©

    © ©

    © which you may return to @

    ©

    ©

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    © balance with your ©

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    @ spiritual realm. ©

    © ©

    @ ©

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    © © © @ © © © © @ © © © © © © © © © @ @ @ © © ©


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    Kana ka "' Aina


    We have also seen or heard of situations where one is not well because of his relationship with 'Aina.


    -••••••••m•••••••••••••

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    : Your pilikia may be because you

    @

    : cannot return to those places ®

    @ you held dear and perhaps even @

    @

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    ©

    © ©

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    ® You may have no land to place @

    ©

    ! your feet upon, and to feel the ©

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    : lepo's (dirt) energy coursing ©

    @

    : through your body and soothing ©

    ©

    ® your soul. @

    @ @

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    : You may long for the fresh :

    ® water streams you recalled :

    : playing as a youth, as it flowed :

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    ©

    ® from the Wai' anae mountain ®

    range to the ocean.


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    ®

    ®

    You can only dream of tasting

    again the mild sweetness of the

    ©

    ®

    :

    @

    ®

    Mountain Apples, and the tart,

    :

    :

    yet healing flesh of the Guava.

    :

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    • • • • • • ® • • • ® • • • • • • • • • • • • • • •••••••®a

    : You may no longer find the plants which served as your medicine, the Wapine, :

    ® Ha' uT, Koli, 'Awa, Laukahi, Limu Kohu, and all those other names you can

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® You cannot find enough Poi to fill your hunger. You long to refresh yourself ©

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: with your 'Aina, but it seems beyond your ability to reach any more. ©

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4


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Kanaka Kanaka (social circles) Disharmony often comes -from one's family, peers, community, church, or other social circles.


©© © ©@ © © ® 0 © © © © © © © © ® ® ©@@ ® © ®0

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© ©

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® Your pilikia may come from ®

® ©

® conflicts with your love ones or ©

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® any tense relationships with ®

: 'Ohana members. :

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: Your pilikia may also come from :

: lack of employment or pressure :

® from one's place of employment. 0

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© ®

® It may be due to some legal ®

: problems, concern over the world :

: at war, disagreements in politics, !

: religions, or cultural practices. :

: People's interaction and conflicts :

® with people can be a major cause ®

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® of one's sense of imbalance. ®

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® Techniques that can be helpful in bringing back a sense of balance :

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within people include group discussions, changing social :

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relationships, becoming involved and taking hold of the problem : @ and trying to solve it, having a safety net of social support, etc. : 0 @

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Most common is the disharmony within your self.


That disharmony may be within an individual, caused by stress, psychological or emotional imbalance, brain chemistry instability,

or other psychological illness.


© © © @ © © @ ® ® © © © © © @ © @ © © @ © © @ © ©

@ ©

® Keeping in harmony may employ a ®

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® number of lifestyle adjustments ®

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: including training and management :

: of one's stress and recognizing :

: areas of vulnerability :

® for that individual. ®

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© @

© @

© Appropriate medication may be @

@ @

@ another technique in maintaining ®

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© balance. ©

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: A change in one's lifestyle, :

: improving social conditions, coming :

® to grips with the reality that one e

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® carries a condition of mental 0

: illness and will have to make :

: accommodations for that illness - :

@ @

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@ these are some of many @ @ ways in addressing the disharmony © Cl!) from within an individual. e

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Let's take some time t o describe our personal wellness model.

6



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Are you satisfied with your spiritual health?

Does anything need to be done to bring balance between yourself and a spiritual element?

Do you believe you are being haunted? Do you carry a curse upon you or your family? Are you living out a prophecy? Are there unresolved grief which you carry for or because of someone who has died?



How well do you get along in your community, in your ohana, with your friends? Are there legal issues you face? What are they? Do you need employment? Are there barriers to your obtaining employment? Are you satisfied with your education background? What are your living conditions? Do you live in a safe place? Are your medical care being properly addressed?

Are you proud of yourself? If so, for what?

Do you feel "out of place" as if you are not really "home?" Would you be happier living somewhere else? Do you long for a place or for an environment other than what you now have? What are you dissatisfied with in the nature which you live?

Are you satisfied with your ability to integrate with nature? Are you happy with your environment?


7

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Hale Na'au Pono ;

Wai'anae Coast Community Mental Health Center, Inc.

:, ;, 86-226 Farrington Highway Wai'anae, Hawaii 96792 ;,

@ Telephone: (808) 696-4211 Fax: (808) 696-5516 ,

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; T lk1·n Storv (Part 3)

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" Identifying Strengths and Weaknesses -B

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nHE POHQ NA KA POHQ

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0 KE AKAMAI NO KE HANA A NUI '0

(Losses come easily; it requires skill and wisdom to avoid them.)

' Olelo No' eau #904

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Problems, weaknesses, headaches, troubles - these pilikia are easy to come by. No effort has to be made. Troubles just seem to roll into people's lives, some troubles bigger than others, for some people, more troubles than for others. Everybody have them. The real measure of wisdom is not how well we cry over our pilikia, but how well we avoid or overcome them. The great work is how smartly we deal with our pilikia.

Pehea 'oe? How are you?

Como esta usted?

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In many different language, this polite inquiry is made as we meet and greet

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people. And in many different fashions, we hear their response. Generally, it's a pat answer - socially acceptable, not too complicated, not too involved, not too

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(Pehea "oe?) Maika" i no.

- (How are you'.>) Fm. e, thank you. -

l--' @ (Como esta usted?) Muy bien. Di--'

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Sometime, however, the answer comes out in a barrage of maladies, bad luck, and other complaints, covering a wide swath of social, physical, mental, economic, political, marital, or other issues.

"I'm depressed again, and my doctor won't see me."


''My back is so bad, I can't get out of bed, unless I take 3 cans of beer to kill the pain first."


"I can't sleep enough at home. When I get to work, I'm continually falling asleep. I think I have ghost in my house. One night I heard •.. "


"I know somebody put a curse on me, and I can't shake it. Now I have 'uhane hele (traveling spirit). I'm losing weight, don't want to eat, and my dose friends don't talk to me any more."


"I keep having this recurring dream. I want to go back home to Koma, but I can not. My family lost our land. Now, this place is not the same. I miss the graves, raising cattle, and that whole life style. Now, my whole family only sit and drink and talk about Kona, but we can not go back."


''Da lolo 1.una told me go dig up the grave. I tol him, "no way brah" and he wen say, "you no dig'um up, den go home and no come back work." So I wen dig'um up. Since den, I all da time hea voices screaming in my pepeiao. "You rotten guy, why you wen dig us up?" Sometimes I see two people who come from the bones I wen find in the graves. Dey follow me, talk to me, scold me, scream at me, make plenty trouble with me. I tell 'um, "get da hell away," "leave me alone." Sometimes I scream at 'um. But dey come back again.


The challenge is not merely to elicit all of the maladies one is experiencing, but to tell about these maladies along a sensible, holistic structure of wellness. By following cm orderly arrangement of the issues, causes, and perhaps, soh.ntions to such maladies, we can pinpoint each issue and develop a plan to address them.


Mahiki - to peel off; to pry; "Think of peeling an onion," explained Mrs. Pukui... "you peel off one layer and throw it away, so you can go on and peel off the next layer. That's rnahiki." Nana i ke Kurnu, Vol. 1, Pukui, pp. 75-76 (See Attachment J)

- ".•. detailed questioning for any helpful purpose is rnahiki. Taking a medical or psychiatric history or a social case history is rnahiki.

"This serious questioning with intent to help is the exact opposite of the purposeless "nosey" inquisitiveness called nzele.

"Knowing and discussing this difference with the Hawaiian patient or client may help change resistance to rapport." Ibid. pp. 76-77


The orderly arrangement Hale Na" au Pono uses to set out the strengths and weaknesses of an individual is the Wai" anae Wellness Model which depicts three

basic points on the triangle - 1) God(s) or the Spiritual realm, 2) man & society (kanaka), and 3) nature or environment C aina).


2

Here are some ideas for initiating discussions along this Wai' anae Wellness Model:


GOD(S) OR THE SPIRITUAL REALM


An important area of a person's life is spirituality. Some people don't like talking with others about their spirituality. Others welcome the opportunity to do so. Let's try the subject and see how far we can get.


How important to you is your sense of spirituality? What religion do you practice?

What religion were you raised in?

Do you have any trouble with your relationship within your religion or belief system? Do you feel there is a need for some work or repair to be made in the area of spirituality?

Do you feel that your illness has anything to do with spirituality, ancestor influence, or a result of something said or done by or against a person who is now deceased?

Is there a part of spirituality you want to work on?

" Making right with ./6 Getting a

God? different name?

.# 1 Learning how to pray?

' Banish certain spirits?

,€ff Strengthening your soul?

.11! Cutting off a

curse?

J!f Addressing ancestors' needs?

.f1r Fulfilling your

obligations: individual, family, ancestral?



3

MAN AND SOCIETY (KANAKA)

  1. Relationship To Others


    Another important area is one's relationship with others. Let's explore this question of relationships, which you may have.

    Do you feel that your illness has something to do with your family?

    What is the root of this pilikia? Who are the people involved?

    Do you have a close relationship with your ohana? What is that relationship?

    Do you feel there are secrets in your ohana which adds to your illness? Can you tel I about these secrets?

    Are there supports for your illness to be found in your ohana?


    Do you feel your illness has something to do with other social relationships?

    What is the root of it? Who are the people involved?

    Are there supports for your mental illness to be found in your social relationships?


    Who do you spend time with regularly?

    Ohana? Congregation? Co-workers? Classmates?

    Why?


    Spouse/ Significant Other? Friends?

    My pets? Myself?


    Do you have a close relationship with your ohana?

    Is there anyone that you would like to spend more time with?

    Who would you say are the supportive people in your life, the ones you can talk to about problems?


    4

  2. Physical Health Issues


    A long time ago, in another land, a guy named Plato spoke of a healthy mind in a healthy body. This truism applies today as never before. Let's talk about this idea and how this applies to you.


    Do you have any physical health problems?

    Are you seeing a doctor for those health conditions?

    What is your preference for means to solve your health problems?

    Western medicine, Hawaiian medicine, Alternative medicines,

    Pule (alone or in combination with la' au Iopa' au (medicine))?


    Do you take care of your physical health? How?


    Are there areas you want to work on to improve/maintain physical health?

    Identify the right doctor?

    Help in being consistent in taking medication?

    Working with others-allowing others to help: Nurse, case managers, family members and friends?

    .fl!? Do exercise regularly?

    , Eat right?


    What medications are you now taking?

    What medications you should not take? What reaction will you have if you took these medicines.

    What illnesses do you suffer from? Do you feel recovery is possible for these illnesses?


    5

  3. Life Style and Daily Routine


Life style and daily routine is probably the most influential factor affecting one's health. It strikes to the very reality of one's lif e 0 setting aside all the t a lking0 promises, int e nt ions0 agreements, hopes and prayers. It's one of the most difficult aspects in someone's life. Ifs unlikely to change unless we lift it up for discussion and examination. Let's telk about it and see what changes can and should come about.


Where do you live? Do you live with family members, spouse, significant other, or roommates?


What is your typical day like?

Do you feel you need to change your current life style? What particular Iif e style do you want to change?

Stop abusive ways-learn to control anger?

Stop illegal drug use --

  1. stop associating with wrong people;

  2. find other friends;

  3. get professional help?

    Stop just sitting around, wasting time, letting the day pass by.

    Get involved in something - school, sports, work, dancing,

    etc.

    Stop hanging with the guys who just do nothing all day.


    6

  4. Leisure Activities/Creative Outlets


    How one chooses to spend leisure time can tell a lot about lifestyle and the possibilities for developing new lifestyles. Not only is it important how one spends leisure time., but how one would like to spend such time if opportunity, resources, or friends were available for such activities. Let's talk about our leisure activities, and what else we would like to do if we could.


    What do you like to do when you have extra time on your hand? What are your hobbies?

    Dance hula?

    Work in the fields? Paddling?

    Surfing?

    Fishing?

    What sports do you like to do/watch on TV? Do you like to read? What kind of books?

    Do you Iike to write or keep a journal? Do you like to play an instrument?

    Do you like Iistening to music? What kind of music? Do you like movies or TV? Which movies or shows? Do you like to draw or do other kinds of art?

    Do you like to look at artwork?


    7

  5. Work Activities and Educational dasses

    One's work plays a major role in how a person identifies oneself. The type of education one has 0 and the choices of classes one selects, are also strong indications of one's hopes for one's future. Let's talk about work and education.


    Are you working (part-time, full-time, volunteer)? What do you do?

    Are you happy with what you do? What would you like to have as a job?

    Are you willing to take classes or special training to help you reach your preferred job?

    Are you in a training program now? Are you taking classes?

    Do you study any subjects on your own?

    Are there any barriers to your getting a job or obtaining further education?

    Are there ways to overcome such barriers?


    8

  6. Behavioral/Emotional problems

A major focus of services to a person with serious mental illness I is to approach the problem from a medical/neurological viewpoint" looking strictly at the chemical O physical, and biological functioning of the human bodyO especially the brain. But this is not the only approach. Another is to treat oneOs mental illness strictly from the psychological standpoint. Others like to call their approach

'

"ed ect ic0 or choosing the best from whatever system works.


Do you have a serious mental illness? Can you name or describe such illness?

How often do you have symptoms which are products of your illness? What are these symptoms? What causes them to occur?

At what point would you consider your condition to elevate to a crisis? How would you identify this stage of crisis?

Do you think your pilikia is viewed as symptoms of mental illness by others? How do you feel about it?

What do you think causes your pilikia? Do you see a psychiatrist?

Do you take medication regularly? Do you think you need medication for your health problems? Do you know about the pros and cons of taking those medicines?

Are you getting Hawaiian or other alternative medicines to help you cope with your pilikia? Would you like such alternative medicines?

What do you do to help yourself prevent crisis?

How does stress off ect you? How do you deal with stress? What helps you cope with your pilikia?

What does the word "recovery" mean in relationship to your pilikia?


9

Previous Experience with Peer-Based Education or Recovery Programs


There has been various types of programs offered to consumers of mental health services. In what types of programs have you been involved?

Recovery program? Self help program? Peer support program? Support group?

Recovery Education program? Alcohol or Substance Anonymous? Family Education program?

Others?

What programs have helped you in your recovery?


Pau


10

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An Effective Method for Solving Pilil<ia and Achieving Goals

When trying to solve a problem or achieve a goal, it is important to take an active, solution-focused approach. You may use a step-by-step method for solving problems and achieving goals by yourself or with your 'ohana members, friends, peers, your case manager or other health care workers. These people can be especially helpful in providing ideas for solutions of the problems you face and in carrying out specific steps of the solution you choose.


image Are you experiencing a problem that is causing stress? Or is there a goal that you would like to achieve but is difficult to pursue?


You can use the following worksheet to develop a plan for solving the problem or achieving the goal.


A Step-By-Step Method:

Step 1 : Define The Problem Or Goal As Specifically And Simply As Possible


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Step 2: List 3 Possible Ways To Solve The Problem Or Achieve The Goal

  1. _

  2. _

C..


Step 3: For Each Possibility, List One Advantage And One Disadvantage


Advantages/Pros:


  1. Disadvantages/Cons:

    1. _


    2. 2

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      Depression

      When people are depressed, they may have one or more of the following problems: feeling bad about themselves, not doing the things they used to enjoy, sleeping too much or too little, low energy, poor appetite, and having trouble concentrating and making decisions.

      If you are not having severe symptoms of depression, you can try the following coping methods to help improve your mood:



      Ways to Cope with Depression

      I Have Used It

      I Would like To Try

      It


      1: Set goals for daily activities, starting with one or two activities and gradually building up to a full schedule.


      I


      I

      2: Talk with someone in your support network to let him

      or her know about your feelings. Sometimes they have good ideas you can try.


      I


      I


      3: Identify things that you still enjoy and build your strengths in those areas.



      4: Schedule something pleasant to do each day, even if it's a small thing. This will give you something to look

      forward to.



      5: Ask people to join you in activities. You may be more

      likely to follow through with plans when someone else is involved.



      6: Deal with loss of appetite by eating small portions of food that you like and taking your time.


      7: Practice relaxation exercises on a regular basis.


      8: Remind yourself of the steps you have accomplished and avoid focusing on setbacks.


      19: Other

      **If you get severely depressed or if you start thinking of hurting yourself or ending your life, you should contact your case manager immediately or seek emergency services.


      7


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      Anger

      Some people find that they feel angry or touchy much of the time and get irate about situations that would ordinarily seem relatively minor.

      Because this is a common problem, there are programs for anger management, which many people have found helpful. Some of the techniques taught in anger management classes may help you control your anger:



      I Ways to Cope with Anger

      I tHave Used

      I Would like To Try

      It

      1: Recognize the early signs that you are starting to feel angry (for example, heart pounding, jaw clenching, perspiring), so that you can keep things from getting out of control.



      2: Identify situations that commonly make you feel angry and learn how to handle these situations more effectively.



      3: Develop specific ways for staying calm when you're angry:

      C. temporarily leaving the situation, or politely changing the subject.



      4: Learn how to express angry feelings briefly and constructively. The following steps are helpful:

      C. Suggest how the situation could be avoided in the

      future.



      5. Other



      6. Other



      1. counting to ten before responding

      2. distracting yourself,

      1. Speak firmly but calmly.

      2. Tell the person what he or she did to upset you. Be brief.


      8


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      Ways to Improve Sleep:


      Sleeping too much or too little can be very disruptive. It's hard to do things when you don't get enough sleep. Trying some of the following suggestions may help:


      I Ways to Improve Sleep

      1 :ave Used

      I Would like To Try It

      1: Go to sleep and get up at the same time everyday



      I

      12: Avoid caffeine after 6 PM II I

      3: Exercise during the day so you'll feel tired at night I



      4: Do something relaxing before going to bed, such as reading, taking a warm shower, drinking warm milk or

      herbal tea, or listening to music



      5: Make sure that your room is dark and that the temperature is comfortable



      6: Avoid watching violent or distressing programs on television or video just before going to bed



      7: Avoid having discussions about upsetting topics just before going to bed.



      8: Avoid napping during the day.



      9: Avoid spending more than 30 minutes lying awake in bed. Instead, try getting up, going to another room, and doing something relaxing (like reading or listening to music) for at least 15 minutes before returning to

      bed.



      10: Other



      11: Other




      9

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      Ito feel enjo-rment

      in it.

      II


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      6: Be willing to try something several times in order to get familiar with it. The more familiar and comfortable you

      feel with an activity, the more likely you will enjoy it.



      7: Other



      II


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      8: Other


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      9: Other



      1

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      Ways to Increase Contact with Others

      Everyone needs time alone. But if you find that you are withdrawing from people and avoiding contact with others, it may create problems in your relationships.

      Ways to Increase Contact with Others

      I Have Used It

      I Would like To Try It

      11: Join A Support Group I



      2: Explore Jobs Or Volunteer Work That Involves Contact With Other People I


      II I

      3: Schedule Contact And Talk Stories With Someone Every Day, Even If It's For A Short Time


      I


      I

      4: If You Find It Stressful To Be With People, Practice Relaxation Techniques Before And/Or After Your

      Contact With Them



      5: Arrange For Errands That Involve Contact With People, Such As Going To The Store Or The Library


      I


      I

      6: If It's Too Stressful To Have Personal Contact, Call People On The Phone And Talk For At Least A Few Minutes



      17: Other

      I


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      11

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      Strategy 3


      Use the help of other people to prevent early warning signs from becoming full blown crises.


      People are not always aware when their behavior has changed and they are experiencing an early warning sign of crisis. For example, someone might not realize that he or she is feeling unusually irritable. Instead, it may seem to him or her that other people are being especially annoying.

      Friends, family members, co-workers, case managers or other health care workers, and other supportive people often notice when someone seems different or is acting out of character. They can help people recognize early warning signs.

      If you ask them, your Ohana/family members, friends and case managers or other health care workers can be your "extra eyes and ears" for noticing early warning signs. You can tell them some possible early warning signs to look for, and let them know that you would like them to inform you when they notice these signs.


      People Who Could Help Me See Early Warning Signs


      Friends: -----------------------------

      'Ohana Members: --------------------------

      Support Group Members: _


      Clubhouse Members: ------------------------

      Case Manager Or Other Healthcare Worker: _


      Co-Workers: ---------------------------

      Others: -----------------------------


      6

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      What can be done when you become aware that you are experiencing an early warning sign of crisis?

      The more quickly you act on early warning signs, the more likely it is that you can avoid a full crisis. The following is a list of examples of what other people have experienced and what they did when they saw early warning signs. Some examples may sound familiar to you.

      • "When I started to feel so irritable with everyone, even my best friend, I realized that I was under a lot of stress with changes in my life. I talked with my case manager about strategies for coping with the stress better so it didn't affect me so much."

      • "I thought my medicine wasn't helping me, so I stopped talking it. My thinking got very confused. I kept forgetting things, too. I told the doctor at my next appointment."

      • "My brother noticed empty beer bottles in the kitchen when he came to visit. When we got to talking, I realized that I was starting to use alcohol to help me fall asleep. The next day I called my case manager."

      • "When I notice I am sleeping too much, isolating myself, or feeling bored; I know I need to call my doctor."

      • "I was not taking care of myself (no bath, no food, messy house, kids running around in the street), and all I wanted to do was sleep. Then I knew it was time to get help."

        When early warning signs are noted, it helps to ask yourself the following questions:


      • Is my stress level high? What can I do to reduce it?

      • Am I taking part in the treatments I chose?

      • Am I going to my support group, doing my relaxation exercises, going to see my case manager, going to church or temple, etc.?

      • If medication is part of my treatment, am I taking my medication as I'm supposed to? If not, how can I make sure I do?

      • Should I arrange a special appointment to talk to the doctor?

      • Do I need to start a medication? Do I need a higher dose of the medication I am taking?

      • Should I contact someone for extra support (like a spiritual leader, Ohana member, etc.)?

7

Question: Have you had an experience where you were able to avoid early warning signs that you checked off on page 4 and 5? If so, what did you do?


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Strategy 4


Develop Your Own Crisis Prevention Plan

It's notpossible to know who will have only one or two crises and who will have more. Making a Crisis Prevention Plan can help you avoid crises and minimize the severity of episodes that do occur.

In developing a Crisis Prevention Plan, you may find it helpful to consult with the supportive people in your life. Friends, peers, case managers and mental health care workers, ohana, and others can help you remember details about what helped in past situations and can make suggestions about possible steps to take if early warning signs appear.

Plans for preventing crises are most effective if they contain the following:


For example, before developing your crisis prevention plan with staff, you may want to talk with the supportive people in your life (Ohana members, friends, your counselor or case manager, and your doctor). You may ask them what they observed before your last crisis and included some of their observations in your list of early warning signs. You may also ask for their suggestions in making a plan for responding to an early warning sign and ask them whether they would be willing to play a specific part in carrying out the plan.

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Questions: What would you include in your Crisis Prevention Plan? You can use the following planning sheet to record your answer.


8

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Public Assistance


Each state offers different financial benefits and has different eligibility requirements. State benefit programs are often called "public assistance" or "temporary assistance for needy families" or "welfare programs." If you have a low income and have mental health problems that interfere with working full-time, you may be eligible for public assistance. It is usually a modest amount of money.

Many states also have programs to assist with the purchase of food, such as food stamps. Many states and communities have programs to help with housing costs. The housing programs may be operated by local housing authorities or by the states.

image

Because public assistance is funded by the state, you would apply at the state Office of Public Assistance or Office of Public Welfare. You may also be eligible for Medicaid health insurance, which is sometimes called "medical assistance."


j Depending On Your Work History And Financial Need, You May Be Eligible For SSI, SSDI Or Public Assistance.

Questions: Are you currently receiving financial benefits?

If not, do you think you might be eligible for SSDI, SSI or Public Assistance?


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Health Insurance Benefits

Are You Entitled To Health Insurance Benefits?

Social workers and case managers are usually well informed about health insurance benefits. The details about these benefits may vary from year to year, so it's a good idea to start by talking to someone who knows the most recent information.

You may be eligible for one of the following health care benefits:


Medicare


If you are unable to work full-time because of mental illness and have been eligible to receive SSDI for more than two years, you may be eligible for Medicare. It usually covers inpatient and outpatient bills, although it is subject to deductibles, co-payments and "ceilings" for certain services. Medicare has two programs, Medicare A and Medicare

B. You can get information about these programs from your local Social Security Office. Even if you are not sure that you will receive Medicare or Social Security, you have the right to apply. Applications are made at the Social Security Administration Office.


7

Medicaid


If you have a low income (or no income) and have mental health problems that interfere with working full-time, you may be eligible for Medicaid, which is called "Medical Assistance" in some states. Even though the programs vary from state to state, they usually cover inpatient and outpatient bills, and medication costs. In some states you are required to pay small co-payments and there are restrictions on reimbursements. You can apply at the State Office of Public Assistance or Office of Public Welfare.


Appealing Decisions

The Social Security Administration and local state programs (such as Medicaid) have ways that you can appeal decisions that have been made about whether you are eligible for services. When you apply, ask about what the appeal process is. If you feel a decision was not made correctly, you have a right to follow the appeal process.

**Depending On Your Work History And Financial Need, You May Be Eligible For Health Insurance Benefits From Medicare Or Medicaid. **

Questions: Do you currently receive health insurance benefits?

If not, do you think you might be eligible for Medicare or Medicaid?


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Speak Up for Yourself

How Can You Advocate For Yourself In The Mental Health System?

You may encounter a problem with the mental health system and may need to advocate for yourself. Here are some examples of problems that other people reported:

"I was on an endless list to see an individual counselor."


"I wanted to get a job. I couldn't find out how to get help with this."


"I was ready to leave the day treatment program, but people kept telling me there was no alternative."

Points To Remember When You Advocate For Yourself:

Keep a record of the details of the problem and what you have tried to do about it

"I kept a copy of all my applications to the apartment program. Also, when I called someone at the housing office, I wrote down the date, who I spoke to, and what we

8

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Questions about What I Receive From the Mental Health

System


Questions

Answers (Please Be Specific)

Are there additional services that I would like to receive?

(see the "mental health services checklist," earlier

in this handout)


Are there any financial benefits that I would like I

to apply for? _

Are there any health insurance benefits I would like to apply for?

Are there any food or nutrition programs that I would like to apply for?

Are there any housing programs or benefits that I would like to apply for?

Would I like to strengthen my skills at advocating I

for myself? _

Would I like to meet the consumer advocate at my mental health center or get to know him or her

better?

Would I like to identify someone on my treatment team who could help me advocate for myself?

Is there anything else I would like to improve aboutI

what I receive from the mental health

system?


PAU

11

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DIE&OLA


Today, what we find is a jumbled flow of at least two distinct deep cultures within the Hawai'i society. One is prominent in the formal and the other in the informal systems of community life. The first contains strong elements of:


Domination - especially reflected in the formal economic, education, political, military and judicial systems. Ingrained within this element is the idea of expansion, an ever enlarging territory, market, or field of conquest as being a natural order of things.

Individualism - protected in the legal system, elevated in the expression of history and dominant Western philosophies. Ingrained within this element is the idea of singularity, a continual parceling apart, fragmenting of things, concepts, persons from people.

Exclusion - often accomplished by the depersonalization of the "other," the stranger. One favorite technique is by referring to others as non-human entities, "gooks" and "commies" for example instead of men, women and children, the "evil empire" instead of the people of another nation.


The acronym DIE is an easy reminder of the elements of that deep culture stream. It is prevalent in the formal economic, education, judicial and political systems of the Hawai' i society today.


The second stream contains elements of:

'Olu'olu - compatible, agreeable, creating relationships of comfort, of inter-relating with a high degree of respect and trust, even alongside one's competitor, of finding contentment with what one has, of staying within one's kuleana, territory or property;

Lokahi - collective effort, many working together for a common goal which gives a foundation for looking at the wide implications of small things,

Aloha - a propensity toward inclusion of other people and different philosophies, a searching out for the humanity within others and trying to urge that humanity to the surface of inter-relationships.


This "OLA." is generally attributed to the underlying Hawaiian culture and the multiplicity of added cultures to Hawai'i. It is entrenched in the informal economy of sharing and caring, of non-formal education, of traditional healing, of alternate dispute resolution systems and community organizing. In the Hawaiian (and other Polynesian) language, it means both health and life.


Of course, one would have to look long and hard to find a pure DIE or OLA in the general community. These deep cultures continually mix, clash, and cooperate within individuals, families, situations, and systems. They add to the schizophrenia and to the compatibility of the society which makes Hawai' i so incomprehensible for some and so delightful to others. These deep cultures are more than interesting anthropological points of inquiry. They have very serious implications to our society. They form the foundation upon which we build our relationships with one another, how we interact with our environment, our attitudes to time, justice, sharing and caring, family, medicine, . . . They are guiding forces to our individual and collective futures.


Excerpt from: On Deep Cultures in Hawai'i, Feb. 14, 2000, Poka Laenui, Institute for the Advancement of Hawaiian Affairs, http:\\www.opihi.com\soverehmty

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What is stigma?


When referring to mental illness, the word "stigma" means the negative opinions and attitudes that some people have about mental illness.

Not everyone with mental illness has experienced stigma, although unfortunately, many have.


There are two major laws that protect against discrimination against people with physical or psychiatric disabilities.


The Americans with Disabilities Act (ADA) makes it illegal to discriminate in the areas of employment, transportation, communication or recreation.

The Fair Housing Act (FHA) prohibits housing discrimination.


Stigma is a complicated problem, and there are no easy solutions. Research has shown that as the general public gets to know more about mental disorders and as they get to know people who have experienced psychiatric pilikia, their negative beliefs go down.


Many organizations are working on national campaigns to educate the public and create more laws that protect against discrimination, including:


The National Institute of Mental Health, (www.nimh.nih.gov) The Center for Mental Health Services, 1-800-540-0320

The National Alliance for the Mentally Ill,(www.nami.org), 1-800-950- NAMI

The National Mental Health Association, (www.nmha.org) The National Empowerment Center, (www.power2u.org)


Strategies and Resources for Responding to Stigma What are Some Strategies for Responding to Stigma?

It may be helpful for you to develop some personal strategies for responding to stigma. There are advantages and disadvantages to each strategy. What you decide to do depends on the specific situation.


Some possible strategies include:


Educate Yourself About Mental Disorders

1

Sometimes people who experience psychiatric pilikia do not know the facts themselves. They may blame themselves for their pilikia or think they cannot take care of themselves or that they can't be part of the community. You may have had these negative thoughts or feelings. This is called "self-stigma."


It is important to fight self-stigma, because it can make you feel discouraged and cause you to lose hope in your recovery. One way to fight self-stigma is to educate yourself about psychiatric pilikia and mental disorders, and to be able to separate myths from facts. For example, knowing that no one causes schizophrenia can help you to stop blaming yourself or others.


Another way to fight self-stigma is to belong to a support group or another group where you get to know different people who have experienced psychiatric pilikia. You can locate support groups through organizations such as the Consumer Organization and Networking Technical Assistance Center (CONTAC, 1-800-598- 8847 or www.contact.org).



The more you know about mental disorders, the more you can combat prejudice, whether it comes from others or from within yourself.


Point Out Inaccurate Information That Others Have About Mental Illness Without Disclosing Anything About Your Own Experience


A co-worker might say, "People with mental illness are all dangerous." You might decide to reply, "Actually, I read a long article in the paper that said that the majority of people with mental illness are not violent. The media just sensationalizes certain cases."



To fight stigma, you might decide to correct misinformation without disclosing personal experience


Selectively Reveal Your Experience With Psychiatric Pilikia


Disclosing information about your own experience with psychiatric pilikia is a personal decision. It's important to think about how the other person might respond. It's also important to weigh the risks and benefits to yourself, both in

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National Stigma Clearinghouse

245 Eighth Avenue

Suite 213

New York, NY 10011 Phone: 212-255-4411

website: community2.webtv.net/stigmanet /HOMEPAGE


Resource Center to Address Discrimination and Stigma

1-800-540-0320

website: www.adscenter.org


Federal Agencies


Equal Employment Opportunity Commission (EEOC)

1801 L Street, NW Washington, D.C. 20507

Phone: 202-663-4900

To locate the nearest office: 1-800-669-4000 website: eeoc.gov

Office of Fair Housing and Equal Opportunity (FHEO)

Department of Housing and Urban Development 451 7th Street SW

Washington, D.C. 20410

Phone: 202-708-1112

website: hud.gov


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method of self-praise. Yet we must unashamed of our principles and honest in our criticisms.


    1. We shall try to avoid conflict and cooperate with those who do not understand us and whom we do not understand; yet, we shall speak our truth openly and stand firm in our own beliefs and right to assert our Hawaiian identity.


    2. We shall be patient, enduring the pains of injustice but never surrendering to or joining such injustice.


    3. We shall respect and engage in humor, the helper to love and affection, the positive expression of humanity.

10.

(To be filled in by you)

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Additional Community Resources



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DIVERSITY IN CONSULTATION 225


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events that define social reality and influence psychological experience and its behavioral manifestations. The macrosystem represents an overarching context that includes historical events such as colonization, decolonization, community, and cultural trauma (Salzman, 2001). A.n analysis of the rela­ ti.on between the macrosystems (i.e., history1 culture) and microsystems (i.e., family, school) is an essential component of the consultation process. Context has received increased attention by counselors and clinicians in support of efforts to promote multiculrural competency in the counseling profession. Pope-Davis, Liu, Toporek, and Britta:h.-Powell (2001) noted that "One of the significant hallmarks of multiculturai counseling is the recogni­ tion that context (sociopolitical,hlstorical,and cultural) is an influential fac­ tor that affects clients' behaviors, attitudes, experiences, world-views, and perceptions" (p. 31). fodeed it is context that frames the manner in which phenomena such as anger may be understood and thereby productively addressed clinically and through consultation services to individ uals1 com­ munities, and organizations. This is particularly true when clinicians and consultants work cross-culturally.

Psychological consultants address a wide range of behavioral manifes­

tations in culturally diverse school settings. Sheridan (2000) described the challenges inherent in applying Conjoint Behavioral Consultation (CBC) across cultures. She noted that the manner in which "problems" are identi­ fied in multicultural CBC must be considered carefully in view of ecologi­ cal factors and contextual factors influencing the participants and therefore the process and outcomes of CBC.

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Social psychology has informed us of the human tendency to attribute cause to the actor while minimizing the contribution of contextual factors. This has been called the fundamental attribution error (Krull, Loy, Lin, Wang, Chen, & Zhao, 1999; Ross, 1977), Suchatendencyrequir.es an.inten­ tional attention to contextual factors to assist the accurate. assessment of behavioral manifestations and to inform a congruent and effective inter­ vention selection. The absence of such intention and attention implies that consultants risk what Shinn and Toohey (2003) identified as context minimization error. This source of error may occur when the impact of con­ texts on human behavior is ignored. Shinn and Toohey reviewed evidence of associations beti.veen neighborhood and community contexts and trends in health, psychological distress1 risky behaviors, psychological at­ titudes, and child development. They found evidence that supported these associations. In addition to community contexts, human-behavior is also embedded in historical and cultural contexts. The probability of error in all phases of the consultation process may be reduced by due consideration.of the meaning and potential functions of symptoms (i.e., anger) in the con-

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RULES (6-10) For En1otional Health In Decreasing the Potential for Relapsing



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6. Supportive/Positive Relationship


9 Willingness

9 Acceptance

AKUA/GOD

(Spirituality)


F alse

E vidence

A ppean.ng

R eal


  1. Relationship that you can be honest about your thoughts and feelings

  2. Talk positively to yourself

8 Remove yourself from harmful situations

  1. Accept that life is about choices and will always bring changes that will require adjusting

  2. Have a plan for the future (HOPE)



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KANAKA/SELF/SOCIETY

7. Positive Talk (Affirmations)

9. Make Positive/Good Choices

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9. Make Adjustment to the Change


ENVIRONIVIENT

  1. Remove myself from drug using situations

  2. Change my environment to a clean, safe and drug free place

Q Paranoia

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Q Auditory

O Hallucinations


Shirley J. Davenport, MSW, CSAAS, (2007): Integrating MISA (Double Trouble) with Wai'anae Wellness Model. Adapted from The Wai'anae Community Mental Health Center, Cultural adaptation of Illness Management & Self Directed Recovery, "Kumu Ola Pono (Voyage to Recovery}". © Shirley Davenport-April 12, 2007

Avoiding Stressor that Lead to Relapse The Stress Vulnerability Model Mental Illness and Substance Abuse


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Higher Power/ Akua (God) Spirituality

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Drugs/Alcohol

Medications


  1. Values

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    Biological Vulnerability

    Doctor I

    Medications

    Faith that Medication works

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    PONO

    Psychiatric Pilikea


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    Kanaka/Society

    Conditions (Aina)

    COPING

    (Me)

    Environment/Nature

(VERY HARD)


Shirley J. Davenport, MSW, CSAAS, (2007): Integrating MISA (Double Trouble) with Wai'anae Wellness Model. Adapted from The Wai'anae Community Mental Health Center, Cultural adaptation of Illness Management & Self Directed Recovery, "Kumu Ola Pono (Voyage to Recovery)".© Shirley Davenport-April 19, 2007

Recognizing The Effects that Criticism Have on Individual The Stress Vulnerability Model

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Mental Illness and Substance Abuse


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Making Any Kind in

Failure / Opportunity

the Community

Resentments Intimidation


Criticism Complaints

Conflicts Psychiatric Pilikea



•-------------------------------

Kanaka/Society / (Me) Phy_sical Environment or Nature

(EMOTIOI\JAL CLASH) (EMOTIONAL NATURE)


Stop Taking Medications

(EMOTIONAL NATURE)

Take Medications Effectively


Shirley J. Davenport, LSW, CSAAS, (2007): Integrating MISA (Double Trouble) with Wai'anae Wellness Model. Adapted from The Wai'anae Community Mental Health Center, Cultural adaptation of Illness Management & Self Directed Recovery, "Kumu Ola Pono (Voyage to Recovery)". © Shirley Davenport - April 26, 2007 (2 of 2)